A review of the published literature does not support the notion that these patients experience increased complications; therefore, we recommend the advice given to breast cancer patients regarding ipsilateral surgery be re-evaluated.
Background: Fixation of displaced intracapsular neck of femur fractures in the elderly are commonly managed with a cemented hip hemiarthroplasty. Guidelines by the British Orthopaedic Association and the British Geriatrics Society recommend that a hip hemiarthroplasty should usually be cemented. However, there is evidence to show that there is a substantial risk of mortality associated with this procedure. Our aim was to find factors contributing to perioperative mortality following cemented hip hemiarthroplasty.Methods: We analysed 94 consecutive patients who underwent cemented hemiarthroplasties (Thompsons) for displaced neck of femur fractures in 2008. All hemiarthroplasty cases were from a busy district general hospital and were cross-referenced with the national hip fracture database registry. We considered factors such as ASA grade, pre-morbid conditions, pre and post-operative early warning scores (EWS) and post-operative events.Results: The risk of mortality was greater with increasing ASA grade. Patients with ASA grade 4 had a 27% risk of perioperative mortality. We found that patients with a past medical history of cardiac disease such as dysrhythmia or left ventricular failure (LVF) had a 30% risk of perioperative death. Those with ischaemic heart disease (IHD) or COPD had a 20% risk. Patients with two or more of these pre-morbid conditions had a 33% risk of mortality. The overall mortality rate within 28 days was 12.8%.Discussions: This study has identified and quantified patients who are at higher risk post-operatively following cemented hip hemiarthroplasty. Using these results, we feel that this "at risk" subgroup need increased pre-operative optimisation as well as higher levels of care (i.e. HDU) both pre-and post-operatively. We feel that these results may justify further investigation into the use of uncemented implants in this patient group.
Introduction:We reviewed the number of nailbed injuries referred to a busy plastic surgery department to identify areas of improvement.Methods: A retrospective study of 142 patients referred over a 12 month period. All notes were reviewed to analyse patient demographics, details of injury, ensuing operation and follow-up.Results: The mean age of patient was 24 years (1 month to 87 years), commonest injured finger was the middle (36%) with commonest cause trapping the finger in a door (33%). 75% of both internal and external referrals were seen within 24 h. All patients underwent operative management and 71% were operated on within 48 h of injury. The majority of operations performed by specialist registrars, under local anaesthetic (LA) and the native nail replaced. 75% of patients were offered follow-up appointments with 15% not attending. The complication rate was 6.4% with abnormal nail growth accounting for more than half. There is no difference in the complication rate in paediatric patients compared to adults. Clinical fellows performing the nailbed repair had an 18% complication rate compared to specialist registrars 1%; consultants and senior house officers had no complications. Having the procedure performed under LA had a 10% complication rate in comparison of 3% under G.A.Conclusions: Nailbed injuries are seen and managed promptly in the department. Complication rates were low and are affected by choice of operator and anaesthetic. More training or supervision may need to be given to non-training post middle-grade surgeons. With the low complication rate, follow-up should be in nurse-led dressing clinics.
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